APOE and Alzheimer disease: For example, diabetes mellitus was associated with both fast and slow rates of cognitive decline in different articles.5,6 In terms of sex, AD has disproportionately affected more women than men; however, the evidence as to whether sex influences the rate of decline is complicated.7,8 The presence of the APOE4 allele has been reported to increase the risk of AD in women,9 yet other studies support estrogen as a neuroprotectant.10